How things look through an Oregonian's eyes

April 05, 2009

Think twice about getting a colonoscopy in Salem (Oregon)

First off, note that I said think twice. Your first thought -- "I should get a colonoscopy"-- is absolutely correct.

The procedure saves lots of lives through early detection and prevention of colon cancer, though recent research shows it isn't as effective as previously thought. Now it looks like colonoscopies prevent 60-70% of cancers rather than 90%.

Last fall an occult (hidden) blood test done as part of my annual physical exam was positive. I asked for a re-test, since I had reasons to think that this was an anomaly. The second test turned out negative.

Regardless, my family doctor and I agreed it made sense for me to get a regular tube-up-the-butt colonoscopy. The procedure is no fun, especially the preparation for it, but colon cancer is a lot worse.

It didn't take long before I was doing my second thinking, because SGA turned out to be a frustrating place for an informed patient to deal with. Since I'd had a previous colonoscopy, albeit a virtual one, I was familiar with the typical preparation procedure.

This involves various dietary restrictions starting a week before the procedure. Then, on the day before the colonoscopy a clear liquid diet is proscribed. No solid food.

Yet when I had my pre-colonoscopy appointment with a SGA physician's assistant, and was given the preparation packet, I saw that the clear liquid diet was to begin at noon two days before the colonoscopy.

Whoa! That was about 14 hours additional waking-time fasting.

Vegetarians like me are used to eating frequently, and I wasn't looking forward to even a 19 hour clear liquid diet (if my colonoscopy was scheduled for 10 am, that's about how many waking hours the usual "day before" prep would last).

I fired up Google and did some research.

The Mayo Clinic said that typically the colon prep is done during the 24 hours prior to the exam. Mass General Hospital, another leading medical center, was more liberal, allowing a light lunch on the day before the colonoscopy.

I couldn't find any prep procedures that started two days before the colonoscopy, though I understood that in special circumstances (constipation, for example) this could be necessary.

My family doctor thought it was entirely appropriate to contact the physician at Salem Gastroenterology Associates who would be doing the procedure and ask about adapting the preparation schedule.

After all, I was a vegetarian who didn't consume nasty colon-clogging animal flesh, and I'd done just fine with a "day before" prep when I had the virtual colonoscopy.

So I wrote Patricia Kao, M.D. a thoughtful, respectful, well-documented two page letter, complete with attachments showing how Mass General and some other gastroenterology clinics handle colonoscopy preps.

I ended the letter this way:

As a final comment, a day or two after I had scheduled this exam I was listening to Dr. Dean Edell on the radio. A woman phoned in with almost exactly the same concerns I had about the colonoscopy prep schedule.

Edell told her that old habits die hard with physicians, that there are alternatives to the “old style” prep, and that doctors learn one way of doing things. He mentioned that his own colonoscopy prep “was horrible” and repeated that there are newer ways of accomplishing this. His ending advice to the woman was to be insistent with her physician.

I don’t particularly like the word “insistent.” I guess I prefer “questioning.” It seems to me that there are good reasons to modify my prep schedule, and I’m confident that we’ll come to a mutually satisfactory agreement on this.

Well, I was wrong. Because I never got to talk with Dr. Kao. Just a front office sort of person, who phoned to tell me that there wouldn't be any changes made to the two-day prep schedule.

I asked, "Why?" The response: "Dr. Kao and Mr. Butler [the physician's assistant] keep up on the latest research and regularly attend conferences."

I told the staffer, "That's nice. But the fact remains that the Mayo Clinic, Mass General, and every other colonoscopy place that I could find on the Internet typically uses a one-day prep, and I'd like to know why Salem Gastroenterology Associates thinks it knows better than the medical consensus."

In reply I got a robotic repeat of "Dr. Kao and Mr. Butler keep up... ."

Everything went smoothly once I made the change to GSO. I was treated like a human being there, rather than a patient who shouldn't ask questions and do whatever I was told.

I didn't agree with everything in the GSO colonoscopy prep guidelines. But at least I could discuss things with staff and get reasons for doing this or that a certain way.

I told them about a "Gourmet Colon Prep" article, written by a nutritionist and physician, which cited research showing that nutritional supplements like Ensure could be taken in addition to clear liquids without messing up the quality of the colonoscopy. Download Gourmet Colon Prep

When I had the virtual colonoscopy, Ensure was allowed. It made a big difference to my uncomfortably empty stomach, providing some substance in addition to the clear liquids.

But I survived without it the second time around. When it came time for the colonoscopy itself, that was the easiest part. I went to sleep about two seconds after the intravenous sedative started flowing and didn't wake up until I was back in the recovery area.

The doctor told me that he found a polyp. It was removed. Turned out to be non-cancerous. I'm supposed to have another colonoscopy in a couple of years.

This shows that it's possible to have a "clean" virtual colonoscopy, and within two years get a regular colonoscopy that turns up a polyp. Of course, the same could happen with regular colonoscopies two years apart.

My experience also taught me that if a physican isn't listening to you and is playing the "Just do it, because I'm the doctor" game, head for another medical provider.

I might have gotten an equally excellent colonoscopy at Salem Gastroenterology Associates. But I lost confidence in that clinic after I was treated like a patient rather than a person.

Interestingly, I began my post-graduate school working career as a Research Associate in Family Practice at the Oregon Health Sciences University Family Practice Department.

One of my jobs was designing patient satisfaction questionnaires for the Family Practice Clinic, so doctors-in-training could get feedback on how they were coming across to patients.

I wish Salem Gastroenterology Associates would have sent me such a questionnaire. (The clinic I ended up going to, Gastroenterology Associates of Oregon, does use a patient satisfaction questionnaire -- and got excellent results.)

But I guess this blog post will serve equally well as a way of saying to them, "Respond respectfully to people when they have questions; doctors aren't gods, and shouldn't be preachy either."

If you live in the Salem area, get a colonoscopy when it is called for. But realize that you have options about where to get it. And what sort of preparation you have to go through.

I stumbled upon this because I'm about to have my second colonoscopy. When I had my first, five years ago, I was a meat-eater, and the prep process was AWFUL. This time, I'm a vegetarian, and it's...well, not exactly delightful, but one heck of a lot easier. That article you linked to gave some great explanation as to why.

Interestingly, about half the places you'll stumble upon say one must avoid cranberry juice during prep; the other half specifically *recommend* cranberry juice. Upon research, it seems that cranberry juice is fine; the problem is that a lot of cranberry juice has red dye in it, which is a problem.

I happen to know that the clinic in Salem you are referring is a great place to have your procedure. The staff is great and the physicians are great. What a shame you feel the need to slander them with half truths. Its people like you that put a bad taste in my mouth. Next time get the facts right before giving wrong information on the internet

Pooper Scooper, what half truths? I simply told about my experience with Salem Gastroenterology Associates. Apparently you've had a different experience.

I didn't put out any false facts. What I said was the truth. Point to any wrong information that I gave before you engage in blanket criticism of my post.

People should shop around for the best colonoscopy provider. If you don't feel comfortable with how a clinic or doctor is treating you, as a patient and a person, this is a sign that you should look elsewhere for treatment.

We're all individuals. A clinic/doctor who appeals to one person might be distasteful to someone else. It's nice that you found the clinic to be a great place. I had a different experience. That's the way life is: full of differences.

Dr. Kao handled mine a couple years ago and I don't remember any problems with the prep. Sunday was somewhat uncomfortable with just the liquid diet and the meds to help "flush", but otherwise, no problems. The best part was on Monday, after waking up, my husband drove me home and I took a nice long nap in the afternoon and then slept all night. For someone who hadn't had a good nights sleep for over two years. I was in heaven.

Kourtney, YOU DON"T NEED TO USE ALL CAPS, because the truth isn't affected by "yelling." No, I don't work for any clinic. I don't work at all, in fact, being pleasantly retired. But thanks for the conspiracy theory.

When you have concerns about anything that has to do with your colonoscopy, including the prep, the GI physician has a duty to answer your concerns BEFORE the exam. If you don't get satisfaction from the office staff, ask the physician to call you personally and if they don't, cancel and go elsewhere. I don't do sedation and scheduling my exam wasn't easy without any but the best GI doc in town personally answered all of my questions and agreed to do an unsedated exam (hard for her but not painful). She even called me at home on the day before the exam to reassure me that it wouldn't be too painful and that I coud get fentanyl (painkiller) if I wanted it...This doc treated me like a king, not a piece of meat. When I thanked her for her kindness, she told me: "that's my job and we need to do whatever it takes to get you screened and to make it as tolerable as possible because we want you to be willing to undergo repeat exams as needed". The exam was easy and I'm having another (unsedated) next year (precancerous polyps).

I stumbled upon this blog looking for another GI office besides Salem. I dealt with them today and found everyone I talked to in that office to be rude, holier than thou people. I wouldn't send a stray dog to them for anything.

This is a really good blog about preparing for a colonoscopy and selecting the right doctor. It is a dreaded experience -- fear of fasting and fear of aesthesia all in one. I am scheduled for one here in South Florida and was hoping to be able to drink Ensure, but looks like not. I for one appreciate your information. Doctors are not the almighty. I want to be able to ask as many questions as I want to and get answers that are not condescending.

My finance is going to go through the prep this weekend. I came upon your article and read it to try and provide him with a non negative prep experience. My question for the day before the prep or 2 days before the procedure is about allowing chicken noodle soup but without vegetables. His instructions from the Harbin Clinic allow well cooked tender vegetables including carrots, celery and green beans, so why the chicken noodle soup minus the veggies?
My e-mail is kiatapps@yahoo.com. If you could respond on this by Saturday, 12-17-2011, I would be grateful. Thank you. Sincerely, Karen L. Freeman.

Hello. I'm glad I fell upon this information.The reason is I have nothing but
trouble with Salem Gsatro. I told them I had a cloting factor. Well, as soon I the Cholo. was off and then the nures called and they where going to the Endo scope Instead, I'm a vegetarian and in Dec. Of last year, I stared getting week and and very tired. I got this Dr., who stated she would take me. I was in there for a vistit. I have Thyroid problem. I was natural Thyroid hormone and The Dr stronghly that armour was not good to because had pocine in that it would cause all kind for me. She did ask any guestions about how I was feeling. well I decided I would go to a specialist and that did not well. I was labeled.March comes and my Physical,cont.

Hello continue from the other post. The Dr. me point blank, I did not have any Iron in my blood, know, If I did not have Iron in my body, I would be dead or in the hospital. she is I believe is a good Dr. so refered me to Salem Gastro. and thats where more started. I would accept the Endoscope. you see have been bledding inside some where. So they sent me to a blood Dr. and cancer Dr. she ran test. and still haven"t any thing done. so Friday I nee to find another Dr. Because, I do not want to die.

all i can say is "they suck" although the doctor seemed ok ....his staff is really a buch of bitchy nasty people. there is no professionlism. my insurance requires i go here . I have barretts syndrome ...pre cancerous. when i called insurance i got very good news . When i called back to ask how much ...they required a deposit and she stated we will set you up with payments ...how about a bill first ...also there using demerol...not good ...this has beem black boxed by fda and salem hospital cont

continues ....so there using demerol which salem hospital black boxed themselves 2 years ago .and here they are using it ..black box ...its not ok to use ...when i asked for other things ..i was told to go to portland ...they refuse to learn new ways ...they are a monoply in salem ..i have decided that i am going to take my chances without endoscopy that risk it with these unethical ,ignorant ,out of touch people ...ps they fought my insurance company company contrac 3 months and took 4 months to get referral done by THEM

Very helpful information and a good point about finding physicians who treat you like a person. I had the same experience this evening when I asked my health care providers if I could take 1 liter, instead of 2, of the saline laxative because I'm a small vegetarian female. Of course they said "no... Just because its protocol".

I've run into their attitude as well. Dr. Em typically comes to our scheduled appointments 45 min-1 hour late. This started after I asked him if we could try actual tests before going down the path of ANOTHER endoscopy regiment.
They have a policy of no second opinions, and you only allowed to change doctors once. Their attitude lacks any empathy with the individuals they service and what they may be suffering.

so I hear they can discover colon cancer in blood tests now. Why do dr send you for these? Prob for the same reason hmo's decide which services are ok.... $. And yes Salem does need another place for these procedures. Cause SGO needs to revisit there office staff and their ephemera, since they don't really have an answering service just a message machine. Saving money on the patient side for the benefit of the corporate side.

I wanted to post my review of Salem gastro- here, because they have no mechanism for reviews to be posted in a way that they cannot be changed. Meaning that if you dig through their difficult to navigate website you will find a questionnaire that you have to print out and then write on, fold up and send in the mail. Obviously by doing this they do not have to post it if they don’t like it.
Now that I got that out of the way I am a Vascular Surgeon here in Salem and this is the third colonoscopy that I have had at Salem gastro-. (Setp 10th) I will go back for a fourth, fifth and sixth time, God willing but I had a mostly pleasant experience.
First the good stuff. When I went back to the pre-procedure room it was a joyous occasion as I saw at least a half a dozen people with whom I worked closely during 25 years of vascular surgery. It was fun pleasant and friendly and they were very efficient and good at what they did. Dr. Ponec is great, the procedure went off flawlessly and I was able to play golf that afternoon. I mention this because in contrast to the first two times I was so sedated that I was unable to do anything for the rest of the day and was still groggy the next morning. They had changed their method such that they used nurse anesthetist, which increases the cost of overall care but the experience was far better.
Now the unpleasant stuff. I arrived at my appointment approximate 10 minutes early. My wife had dropped me off so that she could go for a run and then come back and pick me up. The first bit of unpleasantness was the young woman that checked me in. I will not mention her name but if Salem gastro- sees this and want to do something about they will know who it was. So I walk up to the counter and the young lady says to me- “Are you Rick?” Yes. “Come over here and sit with me.” Now, understand that I’m nervous, even though I’m a physician and had this done before. So I attempted some humor and retorted. “How can I come sit over there with you because you’re over there and there’s a counter between us.” Well she looked at me like I was some kind of a pervert; she turned her head to the right and looked at the lady sitting next to her and made some funny face like who is this pervert and then from that moment on it went downhill. I became nervous and somewhat angry. She acted like a robot. She asked me who was with me. I said my wife and she said where is she? “Out for a run I said. She implied that they might have to postpone the procedure because the doctors want someone in the waiting room; so that really made me nervous. There was no way that I was to postpone this after that horrible bowel prep. So I asked how was I supposed to know that somebody needed to be in the waiting room? She says well they told you that in the telephone conversation. I said what telephone conversation and she says well it says right here that they called you two days. I said that was a computer-generated message to remind me of my schedule I didn’t listen to the whole thing why should I? and why wasn’t that information presented to me ahead of time.
So now are our little meeting is quickly going further downhill; she pulls out an iPad and there are all kinds of disclaimers and this and that three pages and she wants me to sign; so we finally finished that horrible experience and I went back to the pre-procedure room. I have already told you what a great experience that was. One glitch. They took my reading glasses away and then asked me to sign the consent which I signed but of course I couldn’t read. It would’ve been nice to have all of that information that was necessary for me to read sent to me in advance.

SUGGESTIONS FOR SALEM GASTRO
• Make sure that the very first person that the patient sees is friendly, less uptight and more real than the one that dealt with me.
• Anything that is important enough to have me sign as a patient should have been sent to me in the mail or made it clear that there is a website to go to, with an attached link; this could be done by a personal email. I’d like to read it ahead of time if it’s that important. It is not fair to the patient to even expect that they’re going to pay attention to reading this, sitting there nervous waiting for their procedure to be performed. This especially goes with the consent and any disclaimers that you want me to read ahead of time.
• If you want to have someone in the waiting room while a patient is undergoing a procedure, you need to find a way to make sure that they understand that. A computerized phone call two days before is not the way to do it. In this case I was well aware of my appointment and I just thought that the computerized message was to remind me of that; I deleted the voicemail without even listening to it for that reason.
• Because you obviously sent out the instructions for the bowel prep ahead of time you must feel it is the most important thing. It may be to the gastroenterologist, but it is not the most important thing to the patient.
• And while I am on the subject I was not happy having to spend $100 on the new bowel prep that you guys are using. The previous two bowel preps that I had were very inexpensive using magnesium citrate etc. so why the heck did you change? I would say that the new bowel prep is not very cost-effective!
• What would really be nice and it would seem like less of a factory, is to have an actual informed consent with the physician ahead of time during which time all of these important things can be reviewed with the patient, the patient can then take the stuff home and read It. That is certainly what we do in my clinic before any procedure.
• Utilize a local reviewing website like world local so that both positive and negative reviews are posted.

First, I don't know why the lady behind the counter didn't simply refuse to serve you after such a crude attempt at flirtation. Your remarks were uncalled for and in bad taste. Second, it is apparent from you nit picky complaint that you are unreasonably sensitive when it comes to matters that affect you. Furthermore, you admit that you failed to listen to all of the instructions, yet blame others for your failures. I am glad that I have never had the need to use your services. You sound like a spoiled brat.

Several people have commented on this site about Salem Gastroenterology Associates. Both my wife and I have had colonoscopies through SGA without incident over the past few years. My second colonoscopy was just last week, the 8th of September 2016. In the intervening 5 years between procedures I noticed that both the prep and procedure has changed. The prep is certainly easier to go through than five years ago, and the recovery was also much better.

I have found in life that whether we are customers, patients, or clients of a service industry, we are usually treated better than we deserve to be treated. When we are pleasant, we normally receive pleasant treatment in return from those who provide us with services of whatever kind. When we have an attitude that is condescending, or rude, the service providers, while attempting to be pleasant, have a more difficult time responding kindly to those who believe they are superior, especially to those personalities whose attitudes appear, or are, elitist or narcissistic. A couple of the complainers herein who claim to be vegetarians appear to be of that ilk. You get out of life what you put in it.

Have had several scopes with Dr Schultheiss in the last 10 years. As a nurse, I worked with him in the ICU on critical cases; he knows me well.
I had a pre-op appt with him and discussed THOROUGHLY the modifications needed for my prep due to my special needs. The people who complained, did they not have a pre-op appt with their doc? I ALWAYS HAVE and this is where I ask my questions; directly to the physician. All the directions sent to my home CLEARY state your driver must remain in the waiting room for you. If you had bowel prep 25 or 30 yrs ago, you will realize that the new solutions are a miracle compared to the old harsh ones. I like Salem Gastro, trust them, and especially Dr
Ed Schultheiss and his team. They have done so well by me.- Thanks!